Student Learning Outcomes (SLOs): See CLM concept/exemplar for SLOs.
Scenario: Please use your Pearson book for reference
Scenario Identify the Top 3 client
areas for the nurse to
assess.
It is midmorning on the cardiac unit where you work, and you are getting 1. Hypertension
a new patient. G.P. is a 60-year-old retired businessman who is married 2. Mid chest discomfort
and has 3 grown children. As you take his health history, he tells you that 3. Family history of
he began feeling changes in his chest about 10 days ago. He has coronary artery
hypertension (HTN) and a 3-year history of angina pectoris. During the disease
past week, he has had frequent episodes of mid-chest discomfort. The
chest pain responds to nitroglycerin (NTG), which he has taken
sublingually about 8 to 10 times over the past week. During the week, he
has also experienced increased fatigue. He states, <I just feel crappy all
the time.=
A cardiac catheterization done several years ago revealed 50% stenosis
of the right coronary artery and 50% stenosis of the left anterior
descending coronary artery.
He tells you that both his mother and his father had coronary artery
disease (CAD).
He is currently taking amlodipine (Norvasc), metoprolol
(Lopressor), atorvastatin (Lipitor), and aspirin 81 mg/day.
He is retired and says that he spends his days watching television, with
some occasional yard work. He has gained 25 lb. (11.3 kg) since retiring
and admits that he is overweight.
Next GEN NCLEX: What
matters most? Noticing,
Tanner’s Clinical Judgement
model
1. What other information are you going to obtain about his episodes of chest pain?
Assess for the chest pain the time it’s started, the diet. Assess if he followed his medications regimen.
2. What are common sites for radiation of ischemic cardiac pain?
Chest pain is the most common presenting complaint of acute myocardial infarction. The classic
manifestation of ischemia is usually described as a heavy chest pressure or squeezing, a <burning= feeling,
or difficulty in breathing. The discomfort or pain often radiates to the left shoulder, neck, or arm.
3. There are several risk factors for coronary artery disease. For each risk factor listed, mark whether it is <M=
, modifiable or <N= non-modifiable.
4. Based on the history you have so far, circle the modifiable and non-modifiable risk factors in Question 3 that
apply to G.P.
a. __ N_ Age
b. _ M__ Stress
c. __ N_ Gender
d. __M Obesity
e. __M_ Smoking
1
Self-Directed Perfusion Simulation 2025 Spring 2022
f. _ M__ Hypertension
g. __M_ Hyperlipidemia
h. M___ Diabetes mellitus
i. __M_ Physical inactivity
j. _ N__ Ethnic background
k. _M__. Excessive alcohol use
l. __N_ Family history of CAD
5. Although the client has had a prescription for sublingual nitroglycerin (SL NTG) for a long time, the nurse wants
to be certain he is using the medication correctly. Which actions are correct when taking SL NTG for chest pain?
Select all that apply. What is the rationale for each answer- add comment in for each correct action?
a. Call 911 immediately.
b. Stop the activity and lie or sit down.
c. Chew the tablet slowly then swallow.
d. Place the NTG tablet under the tongue.
e. Call 911 if the pain is not relieved after taking 1 SL tablet.
f. Call 911 if the pain is not relieved after taking 3 SL tablets, 5 minutes apart.
6. The nurse reviews the use and storage of SL NTG with G.P. Which statement by G.P. indicates a need for
further education? Explain your answer next to your answer selection.
a. <I carry the tablets with me at all times.=
b. <I will keep the pills in their original brown bottle.=
c. <I will not store other pills in the nitroglycerin bottle.=
d. <I will discard any open bottle of nitroglycerin after a year.=( after 5 months they must be discarded)
7. Complete Medication template for each of the following medications: (1) NTG SL, (2) Amlodipine, and (3)
diltiazem IV.
Case Study Progress
When you first admit G.P., the nurse places the client on telemetry and observes his cardiac rhythm. The rhythm
has periods of faster rates than below.
8. Identify the rhythm: (6 second strip) after answering the questions below to analyze the
rhythm. • Rate: What is the rate? 90
• Regularity: Is the rate regular or irregular? Measure regularity using R waves. Irregular •
P-Wave examination: Is there a P wave before each QRS? No P wave
• P to R interval: Measure P to R interval, is it within normal limits? Is it consistent? No PR interval •
QRS width: Is the QRS narrow or wide? Measure the duration of the QRS complex. ( 0.04-0.06
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